Common Treatments For PTSD Nightmares
Post-traumatic stress disorder (PTSD) is a mental illness that develops due to a traumatic event or a series of traumatic occurrences. The individual may have been directly impacted or witnessed the event occurring.
For some people with PTSD, persistent nightmares can be a distressing symptom. These nightmares may surface directly after the traumatic event has occurred or years later. Regardless of when they appear, the symptoms are often similar, though the severity may vary from individual to individual.
If you’re experiencing symptoms of PTSD, including nightmares, you aren’t alone. It’s estimated that approximately 50% to 70% of those diagnosed with this condition experience nightmares and other sleep disturbances that impact daily functioning. Many treatments can help those affected by PTSD nightmares navigate their symptoms and move forward.
What is the connection between nightmares and PTSD?
Nightmares are a symptom of PTSD and often include imagery or distressing ideas related to a traumatic event someone experienced. For some experiencing PTSD nightmares, the event is relived in the dream exactly as it occurred. For others, it might involve images or symbolism or the fear they might have felt during the trauma. PTSD nightmares can result in sleep challenges, including insomnia and sleep deprivation.
Some PTSD nightmares may occur nightly, whereas others might occur occasionally. Therapists consider the number and frequency of the nightmares when developing a treatment plan. Those with a high frequency of nightmares or nightmares every night may be recommended for medications for PTSD. However, consult a doctor before starting, changing, or stopping a medication.
What is the impact of PTSD nightmares?
Nightmares are a symptom of PTSD and often include imagery or distressing ideas related to a traumatic event someone experienced. For some experiencing PTSD nightmares, the event is relived in the dream exactly as it occurred. For others, it might involve images or symbolism or the fear they might have felt during the trauma. PTSD nightmares can result in sleep challenges, including insomnia and sleep deprivation.
PTSD nightmares differ from frequent nightmares. They often occur earlier in the sleep cycle, making it difficult to fall back to sleep and enter deep sleep. This impact can be harmful, as deep sleep is essential to the immune system. In addition, PTSD nightmares may cause movement during sleep, which might involve kicking, punching the air, or thrashing. Some people talk in their sleep or wake up in sweat from these nightmares.
PTSD nightmares that cause movement during sleep are also potentially dangerous to the individual. During healthy sleep, the body is paralyzed while dreaming to reduce the chance of moving, sleepwalking, or acting out dreams. As PTSD nightmares occur during light sleep, the movement might be involved due to the fight or flight response. This movement may increase the risk of sleepwalking. When this occurs, the sleeping person can swing their arms, kick, or get up and walk, increasing the potential for physical injury to themselves or others.
When do PTSD nightmares occur?
PTSD nightmares can occur in all sleep stages, although they are most prevalent during the first few stages of sleep. The disturbance to the different sleep stages may cause symptoms similar to the impact of sleep deprivation. In addition, frequent waking in the night can cause individuals to not fall into a deep sleep, which may limit the time their body has during the night to adjust.
Some evidence suggests that breathing disorders may initiate PTSD nightmares during sleep. Individuals with PTSD who receive apnea treatment may experience fewer nightmares. However, sleep apnea can produce nightmares even when PTSD is not present. If you’re experiencing nightmares, snoring, and a feeling of exhaustion during the day, consider reaching out to your doctor about a sleep study.
Causes of PTSD nightmares
PTSD is linked to biological changes inside the brain resulting from difficulty with the cognitive processing of traumatic events. Not all trauma survivors develop this disorder, and no single type of event ensures the development of PTSD. As PTSD impacts many areas of the brain, the areas responsible for dreaming can also be impacted. When people with PTSD feel hypervigilant of their surroundings, they might struggle to fall asleep. When they do sleep, their mind may replay images that distress them, waking up to fear or difficulty falling back asleep.
Common treatments for PTSD nightmares
Not everyone with PTSD develops nightmares, but those with this symptom may see a decline in these dreams by attending therapy or seeking medical or mental health intervention. Below are a few of the most common treatments for these nightmares.
Sleep testing
Although treating PTSD can reduce the occurrence of PTSD nightmares, nightmares may sometimes have another cause. If you suspect you may be experiencing a sleep disorder like sleep apnea, consider asking your doctor for a referral to a sleep center to rule out breathing difficulties.
Lack of oxygen while sleeping can incite disturbing nightmares for those who do not have PTSD, and for those who do, the nightmares may be worsened. If a sleep study shows that sleep apnea or other breathing difficulty exists, treatment for that problem could lessen the impact of your nightmares.
Medication
A psychiatrist or medical doctor may be able to provide medicine to reduce the occurrence of PTSD nightmares. New research has found that several medications may reduce symptoms. However, consult your doctor before considering medication, as each person is different, and not all medications may offer the same benefits.
Therapy
Cognitive-behavioral therapy (CBT) is a standard method therapists use to treat individuals experiencing PTSD nightmares. In CBT, clients are taught to revisit the event or events associated with the nightmare to explore their thought patterns. This exploration includes identifying maladaptive or unhelpful thought patterns that create barriers to healing.
When these patterns are uncovered, the therapist can work with the client to overcome these barriers by reframing their understanding of the traumatic event to understand themselves better and develop successful coping mechanisms. Once a client achieves a cognitive shift, PTSD nightmares may subside.
However, note that CBT is not the only treatment effective for PTSD. A few treatments have been developed explicitly for PTSD and have high rates of effectiveness as well, including EMDR and internal family systems (IFS) therapy.
Alternative counseling options
PTSD may be difficult to resolve without professional support. In addition, research indicates that approximately 80% of clients with PTSD present at least one comorbid disorder, including anxiety disorders, depression, and substance use disorders. Therefore, people experiencing PTSD symptoms, including nightmares, may benefit from speaking to a therapist for symptom relief.
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.
Despite its prevalence, some people experiencing PTSD don’t receive quality mental health assistance due to barriers to attending in-person care. These barriers might be related to a lack of flexibility, time constraints, reluctance to travel, or a lack of availability of providers. The rise in online therapy through platforms like BetterHelp has removed many of these obstacles, providing therapy for people who may not be able to get it.
Online therapy allows clients to speak with their mental health professional via messaging, phone, or video calling anywhere with an internet connection. In addition, studies back up the effectiveness of this format, showcasing how treatment methods like EMDR and CBT can be practiced online to reduce PTSD symptoms.
Below are some reviews from clients on how BetterHelp therapists helped them cope with PTSD
“Carmen is really insightful listens to me, and acknowledges my experience and challenges with PTSD. I feel heard and supported. It’s been only a short amount of time but I am confident in her ability to help me.”
“Laurie is helping me to take control of structures and routines in my life to help me overcome anxiety, ptsd, and manage my major depression. I have never been so pleased with a counselor as I am with her. Her first step with me was to ask about my sleep- which I have been waiting for a doctor to ask me about for years (instead of a here try this pill- her strategy is let’s begin at square 1)... Laurie is logical, rational, smart, warm and understanding. I love working with her and feel her support in my corner because she always chats me back in a timely manner. I am truly so grateful for her guidance and care.”
Takeaway
Can PTSD nightmares be cured?
While it may not be possible to cure PTSD nightmares, there are ways to manage and cope with them. Here are a few techniques that may help you understand PTSD-related nightmares and reduce the impact they have on your life.
- Get Treatment: One of the best ways to cope with nightmares and all other symptoms of PTSD is by getting treatment. This may involve various types of psychotherapy like cognitive behavioral therapy, cognitive processing therapy, and eye movement desensitization and reprocessing, as well as specific types of medication or any other treatment modality your doctor recommends.
- Keep a Dream Journal: While it may be difficult to face these nightmares head-on, journaling what you see may help you understand what is occurring and give details of your dreams with a therapist. In addition, some treatments like image rehearsal therapy could help change how one views their dreams in an effort to shift their content from negative to positive.
- Improve Sleep Environment and Hygiene: Poor sleep quality may increase the intensity or duration of dreams. This can come about from an improper sleep environment or inadequate sleep hygiene. Fixing these components can involve finding the right sleeping temperature, avoiding eating or exercising close to bed, staying away from blue light exposure, and avoiding substances like caffeine or alcohol before going to sleep.
What triggers PTSD nightmares?
While individual PTSD triggers and PTSD nightmare causes may vary, there are a few common reasons why a person with PTSD may experience sleep disorders or disturbances.
- Insomnia: One symptom of PTSD is a lowering of sleep quality or an inability to sleep, known as insomnia. PTSD nightmares may play a role in this, as these negative dreams often involve re-experiencing trauma, and it can be difficult to return to sleep after one has awoken.
- Feeling “On Edge”: According to the American Psychiatric Association, PTSD may cause a person to feel as though they are in danger due in part to the effects of hormones associated with the fight-or-flight stress response. As a result, they may find it harder to sleep, and once they do, it's possible they could experience more frequent nightmares.
- Substance Use: Despite their potential to worsen symptoms, the use of alcohol and drugs can be a common coping method for those experiencing mental disorders like PTSD. One effect that substances like alcohol can have is a lowering of sleep quality, which may increase the occurrence of PTSD nightmares, as well as insomnia or other sleep disorders.
How do I stop having trauma nightmares?
One of the best ways to alleviate trauma and PTSD nightmares is through therapy. The types of therapy that may be most effective for you can vary but may include cognitive behavioral therapy, exposure therapy, image rehearsal therapy, eye movement desensitization and reprocessing, and cognitive processing therapy. It may also be possible to reduce the rate at which the symptoms of a nightmare disorder occur by making certain lifestyle changes, like maintaining a regular sleep schedule and creating an optimal sleep environment.
How do you stop PTSD triggers?
While it may not be possible to stop triggers associated with post-traumatic stress disorder (PTSD), there are ways to cope with your symptoms. The first step is often to seek the help of a mental healthcare professional, like a therapist. Through treatment approaches like cognitive behavioral therapy, therapists can help you to recognize your triggers once they occur. This can involve identifying what stimuli aggravate the symptoms of your PTSD, like specific sights, sounds, smells, or physical sensations. By doing so, you may learn to process your trauma and reduce the impact that your triggers can have on you in the future.
What is the best medication for PTSD nightmares?
According to the American Psychological Association, the only medications currently approved by the Food and Drug Administration for PTSD are Zoloft (sertraline) and Paxil (paroxetine). However, one medication that doctors may prescribe off-label is prazosin, also known as Minipress. While the FDA has not approved it for this use and the research is so far inconclusive, prazosin use can lead to a reduction in blood pressure, which may be effective at treating nightmares caused by PTSD. That being said, prazosin is not specifically designed to be a sleep medicine. In addition, you’ll need to consult a doctor before beginning it or any other medication.
What happens after a PTSD nightmare?
A person experiencing a PTSD nightmare may wake up during or after their dream and have difficulty returning to sleep. Because PTSD nightmares often involve reliving a traumatic experience, a person may also be emotionally distressed after they awaken. PTSD nightmares can also cause a person to move around or talk in their sleep, which could disturb other sleeping partners. The combination of these effects could lead to fatigue from lower sleep quality or relationship conflicts due to the disruption of a partner’s sleep.
What stage of sleep do PTSD nightmares occur?
Like all bad dreams, most PTSD nightmares occur during the rapid eye movement (REM) sleep phase. This phase of sleep is typically separated into several different periods throughout the night and can involve increased respiration and irregular heartbeat. PTSD nightmares can be distressing and may result in someone waking up or being unable to get back to sleep. In many cases, the content of these nightmares can relate to a person’s past traumatic experiences, which may cause them to go through feelings of fear or terror upon waking.
How do I know if my nightmares are PTSD?
While the characteristics of PTSD nightmares tend to vary for each individual, one way to know if your chronic nightmares are related to PTSD is by their content. If your distressing dreams contain elements that could be associated with trauma or feature images that directly relate to traumatic memories, that can be a strong indicator that they are PTSD nightmares. In addition, if you find that you awaken suddenly with an overwhelming sense of terror or an increased heart rate, that could also indicate you have experienced a PTSD nightmare.
Can a nightmare traumatize you?
While nightmares themselves may not be directly traumatizing, they can be indications that a person has experienced trauma in the past. In some cases, these nightmares can be a symptom of PTSD, particularly if they contain specific characteristics. These characteristics can vary, but for many. PTSD nightmares will involve images or sensations that mimic those they experienced during a traumatic event. In order to know whether your nightmares are a symptom of PTSD, it's important to consult a medical professional to receive an official diagnosis.
How do you treat PTSD night terrors?
There are many therapeutic approaches that may function as a treatment for PTSD nightmares and night terrors. One study looked at the ways that several different types of therapy can affect sleep in those experiencing PTSD, specifically insomnia-focused cognitive behavioral therapy (CBT-I), imagery rehearsal therapy (IRT), and exposure, relaxation, and rescripting (ERRT). Researchers found that CBT-I alone or in combination with IRT or EERT led to a reduction in nightmares and other post-traumatic stress symptoms.
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